With Robert's help, Huang Jiacai went to inspect several American medical device companies.
Lao Cheng made an on-site inspection at the Hospital for Special Surgery in New York. The hospital sent an administrative staff to accompany him. He conducted an in-depth study of the hospital's culture, management and structure.
After confirming that Yang Ping was not affected by the accident, Robert arranged the surgery according to the original plan. The first surgery was on little Andrew.
Robert had been planning this operation for two years, but he had not performed it because he was not sure.
If you are not sure, you can only wait. There is no turning back after surgery. Once the surgery is broken, revision surgery will not only be difficult, but also have poor results.
Therefore, Robert has been researching, hoping to develop a new surgical method to solve the multi-ligament reconstruction of children's knee joints.
Existing surgical methods cannot even cope with simple anterior and posterior cruciate ligament reconstruction, let alone this kind of multi-ligament reconstruction.
For two years, Robert racked his brains and failed to achieve a breakthrough. It was not until he met Yang Ping that he saw hope in this matter.
Everyone is looking forward to finding out how Yang Ping performs this operation and what level of mentor Robert talks about.
New York's Hospital for Special Surgery has long been at the top of the world's orthopedics. These doctors are used to the feeling of being number one and used to teaching others. During their medical careers, many doctors have never seen a hospital hire someone to perform surgery.
Now Robert has asked a Chinese professor to perform the surgery, and everyone is full of expectations and curiosity.
Because of the existence of epiphyses in children, adult methods are useless. Some people suggest surgery in adulthood, and some people design extraosseous suspension methods. However, the extraosseous suspension method changes the anatomical center of the ligament, and the insertion point cannot be fixed.
Obtaining firm tendon-bone healing is a helpless choice.
In short, in order to operate like an adult, a bone tunnel must be opened. As long as the bone tunnel is opened, the epiphysis will be damaged. Damage to the epiphysis will cause bone development deformity, and in severe cases, the epiphyseal plate will close and growth will be stagnated.
Multi-ligament reconstruction of the knee joint is already very difficult for adults, and even more difficult for children.
In order to watch the operation, except for the doctors on duty in the ward, all doctors in the sports medicine department took a break. No other operations were scheduled on this day.
Many doctors from other departments also came. Professor Jung, who specializes in knee replacement, also took time to come and see Yang Ping's surgery.
Because sports medicine and joint replacement come from the same department of joint surgery, many hospitals are divided into different specialties. One doctor performs both knee replacement and knee arthroscopic surgery.
There is a reason why Professor Jung is so interested in Yang Ping's arthroscopic surgery. There are two key technologies for knee replacement - osteotomy and soft tissue balancing. The ligament balancing technology demonstrated in Yang Ping's surgery is more advanced than the soft tissue balancing of joint replacement.
Difficulty, not on the same level at all.
Professor Jung wanted to see how this Chinese doctor, Robert's mentor, could adjust so many ligaments into a balanced state.
Engineers from OrthoPediatricS also rushed over. They wanted to see how these instruments were used and how to complete the surgery, especially the drill bit that can drill holes in a curve.
OrthoPediatricS manufactured this drill according to Yang Ping's drawings, but they don't know how to use it or where to use it. After all, they are not doctors.
Little Andrew was first in line, and Robert himself acted as an assistant, leading Barrel in positioning and disinfecting the sheets.
Yang Ping brushed his hands, put on a space surgical gown, put on gloves, and entered the position of the surgeon.
The first assistant, the second assistant, and the instrument nurse have already been in place, and ten instrument boxes have been placed on the surrounding instrument tables. They are prepared for emergencies, which is fully reflected here.
Yang Ping has visited the supply room of this hospital. It should be the most complex and advanced supply room in the world. It adopts factory-style and assembly line management. There are more than a hundred operations every day, and each operation has about ten instrument boxes. Some operations exceed
There are ten instrument boxes. Some doctors have their own exclusive surgical instrument boxes due to personal habits.
Every day, more than a thousand instrument boxes are cleaned, collected, inspected, repaired, replaced, sterilized, and packaged after surgery. The entire process is monitored and tracked using a dedicated computer system.
When Yang Ping visited, he found that they were very serious about the inspection of instruments. Every instrument was inspected according to standard procedures. Damaged ones were immediately picked out and new replacement instruments were added on the spot. The efficiency was very high.
Some hospitals do not have equipment in stock and need to be replenished by the manufacturer. They should also register it and replenish it as soon as possible, and all departments will be notified in advance.
Yang Ping looked at each of the instruments used in the surgery, especially those he designed himself, and made sure there were no shortages before Yang Ping officially opened the operation.
Glass protection slowly hangs from the ceiling to surround the surrounding area, isolating the operating table from the surrounding area to ensure the safety of the operating area to the greatest extent.
Preoperative check, opening, insertion of probe, and inspection of various anatomical structures in the knee joint.
The probe can move easily within the child's knee joint and is always located in the gap without any collision with the cartilage.
Every time you change the position of the knee joint, there is no need to wait. The movement of the probe is almost synchronized with the change in the position of the knee joint, and the two work together perfectly.
Stryker's latest naked-view 3D arthroscopy equipment is very easy to use. The image presented on the screen is a clear 3D rather than a two-dimensional plane.
If you should use a probe to palpate, do it carefully; if you should stop and observe carefully, never do it roughly; if you should lift the meniscus, never skip the steps.
Not a single second of time that should not be wasted is wasted. The proficiency of the operation has entered a state of enjoyment.
In the teaching room of the operating room, everyone is watching the video. The entire arthroscopic surgery is completed under the camera. The surgeon also watches the real-time video to complete the surgery, so the surgeon's field of view is the same as the audience's field of view.
It is grand yet delicate, fast yet not impatient, elegant yet not frivolous, and has made the operation artistically appealing.
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Professor Jung is an amateur music enthusiast and has a professional level of violin playing. He not only has the ability to make rational judgments about surgery, but also has emotional judgments.
Surgery can create perceptual charm, which means that rationality has reached its extreme, creating harmony and rhythm invisibly. This level must be a master among masters, and it is definitely not something ordinary people can achieve.
Professor Jung lamented that from the operation of this Chinese man, he could see a kind of temperament---broad, deep, simple, and sensitive. This was not derived from logical reasoning, but from perceptual imagination.
The internal examination of the knee joint has been completed, and the reconstruction of the anterior cruciate ligament has begun. This operation requires the reconstruction of several ligaments.
The instrument nurse was a little overwhelmed and couldn't keep up. Robert had already coached her on the surgical steps many times, and she was mentally prepared, but she still couldn't keep up.
Perhaps the speed of the operation was beyond her imagination, and the sister-in-law became a little nervous. Robert comforted her: "Don't worry, Dr. Yang will stop and wait for you."
Robert was worried that she would collapse. Barrel supported her legs, and Robert helped deliver the equipment. The situation was stabilized.
To prepare the tunnel opening, according to Robert, Dr. Yang will use curved drilling in the sagittal plane to bypass the epiphysis. Everyone is eager to see this step and how Yang Ping performs curved tunnel drilling.
"Curve drilling does not require a guide pin. Currently, we can only drill with our hands. In the future, we can use computer software to navigate. There are three drilling methods: sagittal curve drilling, coronal curve drilling, and horizontal curve drilling. Vector
For curved drilling, in order to avoid damaging the posterior nerves and blood vessels, a small incision needs to be made on the front of the knee for the second curve, and reverse drilling is performed from front to back; for horizontal curved drilling, postoperative stress will be concentrated on the epiphyseal line.
Below, it is easy to cause epiphyseal traction stress concentration, and in severe cases, epiphyseal separation; coronal drilling is the safest, most convenient, and most effective, and can avoid the shortcomings of the previous two drilling methods.
Yang Ping explained while doing it. Robert thought too simply. He thought Yang Ping would perform curved drilling in the sagittal plane. The method he guessed was exactly what Yang Ping eliminated first.
The coronal plane is the imaginary plane that divides a person into front and back halves; the sagittal plane is the plane that divides a person into left and right halves; and the horizontal plane is the plane that divides a person into upper and lower halves.
Drilling holes on the coronal plane curve, this curve will be shaped on the coronal plane.
Start drilling the coronal curve, and the soft drill bit can change the direction at will to perform directional drilling.
"If you are not skilled, you must use a C-arm machine for fluoroscopic monitoring, or use navigation equipment to assist to prevent damage to the epiphysis."
Of course, Yang Ping does not need such complicated auxiliary technology and can drill holes with his bare hands. He is too familiar with anatomy.
Yang Ping's words to Robert were just a reminder: Do not imitate dangerous scenes.
The drill bit starts drilling from the lateral wall of the femoral intercondylar fossa, the anatomical center of the anterior cruciate ligament, toward the outside. Without such a steerable drill bit, this curved tunnel cannot be drilled anyway.
Along the safe zone below the epiphysis, the drill bit follows a preset curve and drills out on the outside of the lateral femoral condyle, and then the soft protective sheath that can be turned is put in to prevent the next drilling bit from damaging the soft tissue. p>
Under the protection of the sheath, the drill bit turns and crosses the epiphyseal line. Above the exit, there is another safe zone and the drill bit drills in. This is in the opposite direction as before, from outside to inside, and it is enough to drill halfway without drilling through. This operation is hidden in the bone tissue and cannot be seen on the screen. In order to confirm that the tunnel did not damage the epiphysis, Yang Ping decided to conduct a C-arm fluoroscopy.
The glass protective cover is raised, everyone avoids it, and the C-arm machine operator performs a fluoroscopy.
The drill bit is still in the tunnel, and the metal shadow is the direction of the tunnel. Above and below the epiphyseal line, the two curved metal shadows are very beautiful and do not damage the epiphyseal plate.
Curved drilling, beautiful curved drilling! Professor Jung was amazed.
Soft drills are often used in orthopedics, especially for drilling in small spaces. In some blind spots, the hard linear drill rod will be stuck and cannot drill, just like a bullet has a blind spot.
So soft drills are widely used. Because the drill pipe is flexible, soft drills can apply stress to change the direction of the drill bit and complete drilling at almost any angle.
However, that can only determine any drilling point, and cannot control the route of the tunnel through which the drilling will pass.
Now this Chinese doctor has designed this set of instruments that can skillfully drill holes in any path.
No wonder Robert became his teacher and secretly went to China to study. Chinese people are so smart.
This doctor not only has superb surgical skills, but is also advanced in philosophy.
The tibial tunnel adopts the same method to complete the curved segmental drilling of the coronal plane.
The tendon is implanted into the bone tunnel, and the two ends are buried in the bone tunnel. The tenofixation method does not use the commonly used micro-flip steel plate suspension fixation, but a novel built-in anchor.
The anterior cruciate ligament, posterior cruciate ligament, medial and posterior structures, medial and lateral structures, many ligaments are drilled in curves and fixed with built-in anchors, making children's surgery as mature as adults.
The combination of new instruments and superb surgical techniques makes this world's top surgery simple and straightforward.
Moreover, the new devices strictly comply with the relevant regulations of the FDA, avoiding the trouble of approval.
"How did Robert know this Chinese doctor?" Jung felt itchy.
A sports medicine doctor next to him shook his head: "I don't know."
"Does Dr. Yang only focus on sports medicine?" Professor Jung asked.
"I heard no, I am good at spine, joints, trauma, and sports medicine!" the attending doctor replied.
Professor Jung was very dissatisfied that this guy Robert had such a good teacher, but he never mentioned it to him.
Stingy, mean, selfish, narrow-minded!
Professor Jung was indignant. He went through all the words he could think of in his mind. Afterwards, he wanted to settle accounts with Robert and settle the accounts properly.
Why, there is such a mentor who never discloses any information.
If you only focus on sports medicine and arthroscopic surgery, you can understand that this instructor is also good at joint replacement!
The last time he went out for a week, he vaguely mentioned that he was going to China to attend an academic conference.
This dishonest person, dishonest person!
"The next one is ready to start." Others reminded Professor Jung.
The second surgery is in another operating room, ready to begin.
